Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit.
Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM10), ozone(O3), nitrogen dioxides(NO2) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season.
Visits increased with increasing PM10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 µg/m3 increase in PM10 adjusted for NO2. In the three-pollutant models (adjusting for NO2 and O3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO2, O3, or PM10 during the colder season (October to March).
Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.
The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.
In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).
Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.
Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.
As the numbers of older adults in Canada increases, there will be a growing need for mental health services for this population. Acute psychiatric units (APUs) provide inpatient psychiatric services for the management of serious mental illness. Understanding the characteristics of older adults in APUs is necessary to determine the range of inpatient services required for this population.
We conducted a population-based study of all adults discharged from APUs in Ontario in a 2-year period, 2008-2010, using administrative databases. We compared the characteristics of older adults (aged 66 years and older) in APUs to those of younger adults (aged 18 to 65 years), including sociodemographics, psychiatric and medical diagnoses, and measures of cognition and functioning.
There were a total of 79 352 discharges from APUs, with older adults accounting for 8.8% of all discharges. Depressive disorder was the most common diagnosis, both in older and in younger populations (32.1% and 29.9%, respectively), while dementia accounted for 19.5% of discharges for older adults. Older adults, compared with younger adults, were more likely to have 2 or more chronic medical conditions (83.8% and 20.5%, respectively), significant cognitive impairment (47.0% and 14.5%, respectively), and moderate-to-severe functional impairment (21.8% and 3.3%, respectively).
Older adults in APUs are a complex group, with mental health and medical care needs that differ from younger adults. APUs must be able to provide adequate psychiatric, medical, and interprofessional services to achieve optimal outcomes. Future studies are required to understand the quality of care and outcomes for older adults in APUs.
Now and then children and adolescents are admitted as emergencies to adult psychiatric wards. The reasons for these admissions are frequently pronounced aggressiveness, behavioural problems, and threat of suicide or intended suicide. The aim of the study was to describe the cause of admission for those children and adolescents (younger than 18 years) that in the period concerned were admitted as emergencies to the adult psychiatric ward in Frederiksberg, Denmark. During the ten-year period concerned there were 42 emergency admissions. Compulsory measures according to the mental health act were used in one-third of the admissions. Forty percent of the admissions lasted more than one month. An arrangement for treatment after discharge was not achieved in one-third of the admissions. The most common diagnoses were adjustment disorder and conduct disorder. On the basis of this retrospective review the need for a locked adolescent ward is considered to be a relevant part of an emergency psychiatric service. There is an ethical problem in those cases where children and adolescents cannot be motivated for treatment after discharge.
The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss possible interventions.
The study was designed as a historical prospective record linkage study of patients with at least one visit to a Danish PER in 1995-2007. Five consecutive 3-year cohorts of individuals aged 20 to
The impact of an aging population on the psychiatric emergency service (PES) has not been fully ascertained. Cognitive dysfunctions aside, many DSM-IV disorders may have a lower prevalence in the elderly, who appear to be underrepresented in the PES. We therefore attempted to more precisely assess their patterns of PES use and their clinical and demographic characteristics.
Close to 30,000 visits to a general hospital PES (Montreal, Quebec, Canada) were acquired between 1990 and 2004 and pooled with over 17,000 visits acquired using the same methodology at three other services in Quebec between 2002 and 2004.
The median age of PES patients increased over time. However, the proportion of yearly visits attributable to the elderly (compared to those under 65) showed no consistent increase during the observation period. The pattern of return visits (two to three, four to ten, eleven or more) did not differ from that of patients under 65, although the latter made a greater number of total return visits per patient. The elderly were more often women (62%), widowed (28%), came to the PES accompanied (42%) and reported « illness » as an important stressor (29%). About 39% were referred for depression or anxiety. They were less violent (10%) upon their arrival. Affective disorders predominated in the diagnostic profile, they were less co-morbid and more likely admitted than patients under 65.
Although no proportional increase in PES use over time was found the elderly do possess distinct characteristics potentially useful in PES resource planning so as to better serve this increasingly important segment of the general population.
Cites: J Am Geriatr Soc. 1986 Feb;34(2):91-43944410
Cites: Gen Hosp Psychiatry. 2010 Jan-Feb;32(1):99-10120114135
One of the aims of the structural reforms in psychiatry has been to reduce the need for involuntary hospitalization. The paper presents an investigation which demonstrates an opposite trend. Involuntary admissions to the acute wards of psychiatric institutions in Oslo increased from 30-50% to more than 80% during the period 1981-1992. The percentage of psychotic patients admitted to hospital has increased, and the number of beds for long-term patients has decreased. Provisions to receive emergency cases were introduced in 1983. The observations presented here are disturbing, and should be fully investigated.
In this paper we compare the acute psychiatric wards in Hedmark county and the catchment area of Ullevål hospital with regard to involuntary hospitalizations and admission rates for psychosis during the period 1989-94. In the former area the percentage of involuntary admissions decreased from 58% to 48% during the period, but in the Ullevål catchment area it remained fairly stable at 85%. The latter area showed a higher percentage of involuntary hospitalizations for both psychotic and non-psychotic patients. The admission rate for psychotic patients was higher in the Ullevål catchment area and tended to increase in the course of the study period. We relate our findings primarily to a higher incidence of psychiatric disorders in a city like Oslo. Structural differences in psychiatric and primary care, especially for long-term patients may also be a contributory factor.